老年股骨转子间骨折Gamma钉固定术后贫血的分析

目的探讨不同年龄段老年股骨转子间骨折患者行Gamma钉固定与术后发生贫血的关系。方法60例老年股骨转子间骨折患者采用Gamma钉固定,比较术前和术后红细胞计数、血红蛋白、红细胞压积的差别,观察不同年龄段患者术后发生贫血的情况。结果手术时间平均（75．44±29．01）min。术后第2天红细胞数、血红蛋白、红细胞压积分别下降（0．791±0．368）×10^12／L、（25．38±11．67）g/L、（7．64±3．34）％,差异有显著性（P〈0．01）。在年龄〈75岁组、75～85岁组、〉85岁组中分别下降（0．858±0．393）×10^12／L、（29．75±12．83）g/L、（7．70±3．79）％;（0．770±0．405）×10^12／L、（23．92±12．58）g/L、（7．68±3．43）％;（0.637±0．333）×10^12／L、（20．00±10．61）g/L、（6．09±3．44）％。3个年龄组间差异无显著性（P〉0．05）。结论老年股骨转子间骨折患者行Gamma钉固定术,容易发生术后贫血,贫血程度与年龄的大小无相关性。     

股骨偏心距改变对老年股骨转子间骨折术后功能影响

目的 探讨老年股骨转子间骨折术后股骨偏心距的改变对关节疼痛和功能的影响.方法 以2017年9月至2019年6月行单侧股骨转子间骨折闭合复位内固定术且符合筛选标准共96例患者为研究对象,根据术后患侧与健侧偏心距的差值分为3组,其中34例术后患侧偏心距较健侧小5 mm(减小组),32例术后患侧偏心距与健侧差值在-5～5 m...     

累及小转子对股骨转子间骨折术后疗效的影响

目的 比较是否累及小转子对股骨转子间骨折行股骨近端防旋髓内钉（PFNA）治疗效果的影响。方法将65例行PFNA治疗的股骨转子间骨折患者根据是否累及小转子分为观察组（累及小转子,33例）和对照组（不累及小转子,32例）。比较两组手术情况、疼痛VAS评分、Harris评分、日常生活能力（ADL）评分及髂腰肌肌力。结果 患者均获得随访,时间12～14个月。手术时间及术中出血量两组比较差异均无统计学意义（P> 0.05）。首次完成直腿抬高时间、首次下地时间、住院时间对照组均早（短）于观察组（P<0.05）。疼痛VAS评分：术后1 d、3 d、1周、3周、6周及3个月疼痛VAS评分对照组均低于观察组（P<0.05）,而术后6、12个月两组比较差异均无统计学意义（P> 0.05）。Harris评分及ADL评分：术后1、6周及3、6个月对照组均明显高于观察组（P<0.05）,术后12个月两组比较差异无统计学意义（P> 0.05）。髂腰肌肌力：术后3 d、1周、3周、6周、3个月、6个月、12个月对照组均强于观察组（P<0.05）。结论 未累及小转子的股骨转子...     

蔗糖铁联合使用重组人促红细胞生成素治疗老年髋部骨折贫血的临床疗效观察

目的:分析蔗糖铁联合使用重组人促红细胞生成素治疗老年髋部骨折贫血的临床疗效。方法:自2016年2月至2018年4月行髋部骨折手术96例老年贫血患者根据治疗方式分为3组,3组患者均在术前3 d接受抗贫血治疗,其中A组32例单独使用蔗糖铁,B组32例单独使用重组人促红细胞生成素,C组32例联合使用蔗糖铁和重组人促红细胞生成素治疗,观察比较3组的治疗效果。结果:临床有效率C组显著高于A、B组患者(P0.05)。3组患者围术期失血量比较,差异无统计学意义(P0.05),但C组输血率明显低于A、B组患者(P0.05)。用药前,3组血红蛋白、红细胞计数比较,差异无统计学意义(P0.05),但术后1、3、5 d,C组患者上述指标均明显高于A、B组(P0.05)。用药期间,药物不良反应发生率3组间差异无统计学意义(P0.05)。结论:与单一用药相比,蔗糖铁联合使用重组人促红细胞生成素治疗老年髋部骨折贫血效果确切,不仅能够有效改善患者血红蛋白水平,保障手术顺利进行,还可降低患者的输血率,促进其术后康复。     

VitE与促红细胞生成素治疗透析患者贫血的观察

我们使用VitE和促红细胞生成素治疗透析患者的贫血,取得了一定的疗效,现报道如下。     

肾移植后贫血患者早期应用促红细胞生成素的临床效果分析

目的 研究肾移植后贫血患者早期应用促红细胞生成素(EPO)的效果。方法 回顾性分析在苏州大学附属第一医院行肾移植手术的患者,其中术后使用促红细胞生成素治疗者为EPO组,未予以EPO治疗的为常规组。排除术后发生肾功能延迟恢复的受者,对余患者进一步统计分析,比较两组的一般资料、实验室资料和随访情况,观察药物不良反应。结果 EPO组术后第2周血红蛋白(P=0.026)、红细胞计数(P=0.038)、血细胞比容(P=0.011)均高于常规组,且术后血肌酐水平较常规组更低(P=0.001)。自术后第1周,EPO组网织红细胞计数显著高于常规组(P<0.01)。分析血红蛋白与血肌酐的相关性,EPO组在术后第1周(r=-0.375,P=0.010)、第2周(r=-0.386,P=0.008)均呈负相关。用药期间,除6例患者出现一过性血钾升高,予对症处理后恢复正常,余未见明显药物不良反应。结论 肾移植患者术后早期持续应用EPO,可明显改善肾移植患者的贫血状况,进一步促进移植肾功能的恢复。     

单侧骨折外固定器治疗股骨转子间骨折

我院采用单侧成角度外固定器治疗股骨转子间骨折,效果显著。现报告如下。临床资料50例中男30例,女20例;年龄35～89岁;右侧35例,左侧15例;Boyd分型法:型5例,型15例,型20例,型10例。治疗方法连硬麻后,患者仰卧于复位架上。C型臂X线透视机下复位成功。保持患肢外展45°,内旋15°。准备穿针。近端在大转子外下方的1～3cm处穿两枚针。左股骨大转子外下方1cm处穿入第1枚针,纵行切开约1cm长切口,分离软组织,平行股骨颈纵轴方向钻孔至股骨头软骨面下0.5cm处,然后换上固定的螺纹针拧入(拧螺纹针时只许进不许退,以免针道松动)。第一枚针固定后装上模…     

Richasd钉治疗股骨转子间骨折

我科从1993年4月至1996年4月应用RIChCSd钉（即加压滑动鹅头钉）治疗股骨转子间骨折36例，取得满意疗效，现报告如下。临床资料一、一般资料：本组男性28例．女性8例。年龄最大者为83岁，最小者为27岁，平均52岁，其中60岁以上11例。骨折类型（Evan法）：I型1例，I型5例，N型15例，N型10例，逆转子间型5例。二、治疗方法和结果：术前胜骨结节骨牵引4～10天，均采用连续硬膜外麻醉。手术时lfo70～120分钟。术中输血23例，输血量400～800毫升。术后l～3周挟双拐下地行走，根据骨折愈合情况弃拐时间6～10周。本组1例68岁女性病人术后10天因…     

左卡尼汀联合重组人促红细胞生成素治疗肾性贫血的临床观察

目的:观察左卡尼汀联合重组人促红细胞生成素治疗肾性贫血的疗效.方法:将70例尿毒症维持性血液透析患者随机分成治疗组和对照组,两组患者均于血液透析后静脉注射重组人促红细胞生成素,同时治疗组每次血液透析后静脉注射左卡尼汀100mg/次,疗程3个月.结果:治疗组的血红蛋白(Hb)、血红细胞比容水平显著高于对照组(P＜0.01).治疗组于治疗后第3个月促红细胞生成素用量较治疗前明显减少,而对照组促红细胞生成素用量无明显改变.结论:左卡尼汀能减少促红细胞生成素的用量,提高其疗效,纠正肾性贫血.     

重组人促红细胞生成素对降低老年股骨粗隆间骨折围手术期输血的病例对照研究

目的:评价术前应用重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)对降低老年股骨粗隆间骨折择期手术患者围手术期输血的作用.方法:回顾性分析自2011年1月至2013年12月收治的老年股骨粗隆间骨折患者442例,根据纳入及排除标准,最终入选119例.其中治疗组52例,男12例,女40例,平均年龄(71.4±12.8)岁,术前接受rHuEPO 10 000 U(隔日1次)加右旋糖酐铁200 mg(每日3次);对照组67例,男16例,女51例,平均年龄(70.9±16.2)岁,术前仅接受右旋糖酐铁200 mg(每日3次).所有患者采用PFNA-Ⅱ(辛迪思公司)或Intertan(施乐辉公司)在闭合复位下固定骨折,观察两组患者围手术期输血率、平均输血量、术后并发症、住院时间及30 d内死亡率.结果:119例中71例围手术期接受了至少1U(200 ml)异体血输入.治疗组围手术期输血率48.1％,低于对照组的68.7％(x2=4.77,P＜0.05);治疗组平均输血量(1.8±0.4) U/pte,低于对照组的(3.6±1.1) U/pte (t=2.244,P＜0.05).治疗组术后1周及30 d血红蛋白水平高于对照组,且治疗组术后30d较入院时血红蛋白水平高.两组术后血栓事件、术后感染发生率及住院时间比较差异无统计学意义.结论:对于择期手术的老年股骨粗隆间骨折患者,术前应用rHuE-PO可降低围手术期输血率及平均输血量,但其长期安全性仍有待评价.     

单次不同剂量重组人促红细胞生成素治疗肾性贫血的临床研究进展

贫血是在慢性肾脏病(CKD)进展过程中最为常见的并发症。红细胞生成素主要是由肾脏产生的一种糖蛋白,用于调节红细胞的生成,它的缺乏是肾性贫血的重要原因。诸多研究显示,对于Hb水平不达标的患者,运用单次大剂量(每次10 000 IU)的重组人促红细胞生成素(rHuEPO)治疗是有效的和安全的。本文就肾性贫血患者的Hb水平现状、不同剂量rHuEPO给药方式的药代动力学特点及相关临床应用及进展予以综述。     

重组人促红细胞生成素对大鼠脊髓损伤后中性粒细胞趋化因子表达的影响及意义

目的 探讨重组人促红细胞生成素(rHuEP())对大鼠脊髓损伤后中性粒细胞趋化因子(CINC-1)表达的影响。方法 SD大鼠102只,随机分为4组,采用改良Allen’s脊髓损伤打击模型,以逆转录一聚合酶链反应(RT-PCR)法测定伤段脊髓组织CINC-1mRNA的表达情况。结果 正常脊髓组织内存在CINC-1mRNA的表达,脊髓损伤后CINC-1mRNA表达迅速增高,伤后6h达到高峰;rHuEPO治疗组脊髓损伤后6、12小时CINC-1mRNA表达明显低于NS治疗组.结论 CINC-1参与继发性脊髓损伤过程,rHuEPO抑制脊髓损伤后CINC-1mRNA的表达,对脊髓继发性损伤可能有保护作用,、     

Long-term effects of recombinant human erythropoietin on bone marrow progenitor cells

Eleven uraemic patients were treated with recombinant humanerythropoietin (rHuEpo). Seven haemodialysis patients and fourperitoneal dialysis patients received a starting dose of 80IU/kg i.v. and 40 IU/kg s.c. respectively, thrice weekly. Thenumber of burst-forming-unit erythroid (BFU-E), colony-forming-uniterythroid (CFU-E), granulocyte-monocyte (CFU-GM) and megakaryocyte(CFU-Mk) were assayed 2 weeks before (DO), and 1 (M1) and 6months (M6) after the initiation of rHuEpo treatment by meansof a commonly applied in-vitro clonal assay. All the patientsshowed the same haematopoietic response. A significant increaseof CFU-E and CFU-Mk could be observed within 1 month of treatment.At this time, no significant modification was observed in BFU-Eand CFU-GM number. At the 6th month the increase of CFU-E wasmaintained, whereas a significant fall of BFU-E, CFU-GM andCFU-Mk was observed. These results suggest that in-vivo effects of rHuEpo are notrestricted to the erythroid lineage but that erythropoietinmight also act as a co-factor of megakar-yopoiesis. In the longterm erythropoietin might induce erythroid differentiation inmultipotent progenitor cells at the expense of the non-erythroidprogenitors.     

Effects of recombinant human erythropoietin on echocardiographic findings in elderly dialysis patients

Summary: Twenty anaemic, normotensive and elderly patients on both haemodialysis and CAPD with left ventricular hypertrophy (LVH) were undergoing systematic echocardiographic analysis during treatment with recombinant human erythropoietin (rHuEPO) for 12 months. Before and after the rHuEPO treatment, M-mode and pulsed Doppler echocardiographic were performed and haemodynamic parameters were closely followed. Partial correction of anaemia resulted in a decrease in the LV end-diastolic diameter (LVEDD) from 56.0±2.0–49.2 ± 2.0mm ( P <0.05) in HD patients and 50.5 ± 4.0-43.6 ± 3.0mm in CAPD patients ( P = NS). Concomitantly the calculated mass index (LVMi) was reduced significantly from 232.3 ± 21.8-185.9 ± 11.4 g/m² in elderly haemodialysis patients. Heart rate and arterial pressure did not change during the study period. However, in CAPD patients there was no significant change in LVMi during the study period. We conclude that long-term amelioration of anaemia in dialysis patients could induce a regression of left ventricular hypertrophy. However, in CAPD patients, both myocardial and haemodynamic effects were less evident. CAPD could possibly modulate the haemodynamic changes associated with the rHuEPO treatment or CAPD itself impose less left ventricular wall stress in these elderly patients.     

重组人红细胞生成素治疗脊髓冲击性损伤的实验研究

[目的]研究重组人红细胞生成素(recombinant human erythropoietin,rh-EPO)对脊髓冲击性损伤的治疗效果。[方法]24只新西兰白兔采用重物坠落的方法造成脊髓冲击性损伤。损伤12 h后,对照组静脉给予生理盐水;小剂量组、中等剂量组和大剂量组分别静脉给予rh-EPO 100、500、1000 IU/kg。损伤后24 h、48 h、1周评估下肢神经功能。损伤后1周时处死动物,脊髓标本进行HE和Caspase-3组化染色,电子显微镜评估超微结构损伤。[结果]EPO治疗组的神经功能评分明显高于对照组,HE染色和电子显微镜显示组织和超微结构损伤明显轻于对照组,Caspase-3阳性细胞数明显少于对照组。中等剂量组和大剂量组的治疗效果无显著性差异。[结论]脊髓冲击性损伤后12 h给予人红细胞生成素可减轻脊髓的组织和超微结构继发性损伤,并可对抗神经细胞凋亡,促进脊髓功能恢复。中等剂量EPO是治疗脊髓损伤的适当选择。     

Exercise tolerance after anaemia correction with recombinant human erythropoietin in end-stage renal disease

The aim of this study was to evaluate the effect of correction of chronic anaemia on the physical performance and the cardiovascular response to effort in children with end-stage renal disease (ESRD) maintained by haemodialysis. Seven patients (mean age 13.9 years) underwent triangular-type treadmill exercise testing before [haemoglobin (Hb) 6.3±0.9 g/dl] and after (Hb 11.2±1.2 g/dl) anaemia correction with recombinant human erythropoietin (rHuEPO). After treatment, the work-load reached, the peak oxygen uptake and average ventilatory anaerobic threshold (VAT) values were significantly increased (P<0.01,P<0.001,P<0.05 respectively). VAT values, expressed as a percentage of normal values, increased from 55.7±16.6% to 82.4±21%. This improvement correlated well with the increase in Hb (r=0.79). Oxygen pulse also increased significantly, when tested after anacmia correction. In conclusion, these data demonstrate that when the anaemia of children with ESRD is corrected with rHuEPO, there is a clear improvement in acrobic work capacity and effort tolerance.     

Effect of recombinant human erythropoietin on erythropoiesis in homozygous sickle-cell anaemia and renal failure.

The development of end-stage renal disease (ESRD) in patients with sickle-cell anaemia results in increased transfusion dependence, increasing the risk of iron overload. Correction of anaemia with recombinant human erythropoietin (rHuEpo) in dialysis patients might also result in stimulation of haemoglobin F production, which protects against sickling, although very high doses were required to achieve this effect in non-uraemic animals. rHuEpo was administered to three transfusion-dependent patients with ESRD and homozygous sickle-cell disease (initial dose 100 U/kg twice weekly, increasing to 125 U/kg at 6 weeks, and to 150 U/kg at 9 weeks in two patients). This resulted in reticulocytosis and increased circulating erythroid blast-forming units. Total haemoglobin was predominantly HbA (i.e. transfused blood) at the start of the study, reflecting transfusion dependence, but after 3 months' treatment was between 60 and 94% HbS. No sickling crises occurred. Haemoglobin F remained at less than 3% of total haemoglobin. One patient was withdrawn at 10 weeks with CAPD peritonitis. The other two patients completed 12 weeks' treatment without transfusion but final Hb concentrations were 4.5 and 5.5 g/dl. Whether larger doses of rHuEpo will be more successful in managing such patients remains unclear. No effect on HbF production can be expected.